A recent Defense Department/University of Pittsburgh study confirms three important points made in prior posts:
- So called “mild” traumatic brain injury (“mTBI”) can have long-term, disabling consequences (in both civilian and military populations);
- that this injury is heterogeneous in both presentation and clinical outcome (in other words, every injury is different); and
- that interventions targeted to the individual presentation of the injury (whether it is predominantly vestibular, cognitive, oculomotor, headache, sleep or mood related, or some combination) can reduce symptoms in otherwise intractable patients.
The message is that ignoring the symptoms and hoping that they will ultimately disappear – the approach often taken in the past – is not wise for either the individual or for society as a whole.
“Prescribing treatments targeted to the individual’s unique symptoms/impairments elicited large treatment effects for the patient’s primary needs,” the authors conclude. Further, they add, “prescribing multiple targeted treatments using a clinical profile framework can elicit large improvements in symptomology across multiple domains, as observed in patients with psychiatric and sleep profiles in the present study.”
As counsel to plaintiffs in TBI cases, it is common to hear from defense experts that since most people recover from mTBI, those that do not are likely malingering, either intentionally or unintentionally. This of course ignores physical evidence of injury found in patients with chronic symptoms, as discussed in other posts. It is also premised on the notion, now almost universally rejected in the medical field, that mTBI is a “homogeneous” condition, like a broken leg. The fact that one patient gets better and another patient does not is a function of the complexity of the biochemistry and architecture of each unique brain and the infinite ways the brain can interact with external forces. This false assumption of homogeneity has in the past led to the false conclusion that since most people get better over time without treatment, everyone will. As this defense study demonstrates, treating each injury as unique and identifying and treating the predominant symptoms in each patient yields far better result.
